Implanting Durable VAD Systems in Patients on VA-ECMO: Comparing Less Invasive to Sternotomy Approach. On Behalf of ECMO-VAD Study Group

Abstract

Patients on veno-arterial membrane oxygenation (VA-ECMO) are high-risk candidates for durable ventricular assist device (VAD) surgery. The aim of this study was to compare the outcome of patients who received durable VAD on VA-ECMO using less invasive (LIS) vs. sternotomy approach. Data of eleven high volume VA-ECMO/VAD centers are collected and evaluated to identify patients who underwent VAD implantation after ECMO support between January 2010 and July 2018. Preoperative parameters and postoperative outcome are analyzed. A total of 531 patients met the inclusion criteria. Nineteen patients were supported with Cardiowest TAH and were excluded from this analysis. The remaining 512 patients were 1:3 propensity score matched and resulted in 99 patients remained in LIS group vs. 293 patients in sternotomy group. The total surgery time was significantly longer in the sternotomy group (270±80 vs. 203±61 min; p<0.001). The postoperative chest tube Output was comparable between the groups (p= 0.476). The number of postoperative PRBC, FFP and platelets given were comparable (p=0.296, 0.081 and 0.111 respectively). A temporary postoperative RVAD was necessary in 37% vs. 43% of the patients in LIS vs. sternotomy, respectively (p=0.353). Surgical re-exploration for bleeding was necessary in 39% vs. 34% of patients in LIS vs. sternotomy (p=0.345). Stroke rate was not statistically different in both groups (25% vs 17%, p = 0.097). Renal and liver failure rates were comparable with 31% vs. 30% and 28% vs 22% (LIS vs. sternotomy, p= 0.762 and 0.173). Comparison of the postoperative outcome between the two groups demonstrated superior short and long-term survival for LIS patients (p=0.015) (Figure 1) CONCLUSION: This study shows that LIS approach may be superior to sternotomy approach for patients on VA-ECMO. The postoperative morbidities were comparable. However, a superior short and long term outcome was observed in LIS Group.